Healthiest Women Initiative & Advisory Committee Eliminating
Racial and Ethnic Disparities in Birth Outcomes
September 8, 2011
Molina Healthcare of WisconsinTom Culhane, MDChief Medical Officer
Molina: company mission
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“All people deserve
respect. When they’re
down on their luck, they
need it more.”
C. David Molina, MD, MPHFounder
Our mission is to provide quality health services to financially vulnerable
families and individuals covered by government programs
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What We Stand For
Molina Healthcare of Wisconsin
Molina is committed to NCQA as the backbone to what we offer
Molina helps patients get the care they need when they need it
Molina is focused on Medicaid and other government sponsored programs
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30 Years Experience Partnering with State Governments
Molina has a proven track record of meeting and exceeding the standards set for managed care health plans
Molina Healthcare of Wisconsin
“I hope that no one ever
forgets that it all began with
a single clinic.”
C. David Molina, MD, MPHFounder
1965 Establishment of Medicaid
1997 Establishmentof Children’sHealth InsuranceProgram (CHIP)
2003 Medicare Modernization Act
2009 - 2010 Healthcare Reform
1985 PCCMcontract
2006 Awarded MASNPcontracts
1980 Molina primarycare clinics foundedin California
1969C. David Molina attends UCLA to earn MPH
Johnson Clinton ObamaBush
2003
Completed successful Initial Public Offering
Launched Medicare MAPDProduct
20081.5 MillionMembers
Federal Healthcare Initiatives
Acquired Abri HealthPlan –Wisconsin (9/10)
Hispanic Business ranks Molina #1 (6/10)
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Quality and Value
Molina Healthcare of Wisconsin
NCQA Accreditation Scheduled: Molina Healthcare of Missouri ‐
June 2011 Molina Healthcare of Wisconsin ‐
2013
California (MHCA)Washington (MHWA)Utah (MHUT)Michigan (MHMI)New Mexico (MHNM)Ohio (MHOH)Texas (MHTX)Missouri (MHMO)Florida (MHFL)Wisconsin (MHWI)
1989199519961998200420052006200720082010
State Inception
Medicare <2%
TANF 80%
CHIP 8%
Aged, Blind &
Disabled 10%
Business Snapshot
Managed care membership profile
1.
Virginia clinics provide Direct Delivery.2.
Molina acquired the Wisconsin health plan on Sept. 1, 2010. As of Dec. 31, 2010, the Wisconsin health plan
had approximately 3,000 Medicare Advantage members covered under
a reinsurance contract with a third
party; these members are not included in the membership count shown above.3.
Florida has a managed care program as well as a Pharmacy Rebate Program.
Managed care membership growth(in thousands)
893
1,0771,149
1,256
1,455
1,613 1,647
2005 2006 2007 2008 2009 2010 1Q 2011
Molina Healthcare of Wisconsin7
Molina Healthcare’s Quality ProgramsDisease management for CHF, COPD,
Breathe with Ease (asthma program), Hypertension and
DiabetesCase management for members with
chronic complex diseases24/7 Nurse Advice LineHealth Education Healthy Baby and Me SM
> Medical Home Pilot – high riskMotherhood Matters SM
> Prenatal Program
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Molina has provided quality healthcare to financially vulnerable
families and individuals
through quality care programs for over 31 years.
INTERNATIONAL COMPARISONS OF INTERNATIONAL COMPARISONS OF INFANT MORTALITY RATESINFANT MORTALITY RATES
20052005Rank Country Rate
1 Singapore 2.12 Hong Kong 2.4
10 Belgium 3.717 Denmark 4.426 Cuba 6.230 United States 6.9
MODs Peristats, 2009
In obstetrics. . .In obstetrics. . . many of our outcomes or many of our outcomes or
their determinants are their determinants are present before we ever present before we ever
meet our patientsmeet our patients
Intendedness of conception Interpregnancy intervalMaternal ageExposure ART/ovulation stimulationSpontaneous abortionAbnormal placentationChronic disease control Congenital anomaliesTiming of entry into prenatal care
Important Examples
Over time, it has come to be realized Over time, it has come to be realized that that
Preconceptional Health PromotionPreconceptional Health Promotionprovides a pathway to provides a pathway to
the the Primary PreventionPrimary Prevention of many of many poor pregnancy outcomes poor pregnancy outcomes
beyond that available through beyond that available through traditional prenatal caretraditional prenatal care
Preconception health Preconception health promotion and health care are promotion and health care are not new concepts; they have not new concepts; they have been gaining momentum for been gaining momentum for
the last three decadesthe last three decades
Freda, Moos & Curtis. MCHJ, 2006;10:S43
Recent Developments in Preconception Care
In 2005, the CDC convened the Select Panel on Preconception Care comprised of specialists in
obstetrics and gynecology, nursing, public health, midwifery, epidemiology, dentistry, family
practice, pediatrics and other disciplines.
In the same year, CDC hosted the first National Summit on Preconception Care.
Action StepsResearch – Surveillance – Clinical interventionsFinancing – Marketing – Education and training
RecommendationsIndividual Responsibility - Service Provision
Access – Quality – Information – Quality
Assurance
GoalsCoverage – Risk Reduction
Empowerment – Disparity
Reduction
VisionImprove health and pregnancy
outcomes
CDC Definition of Preconception Care
Preconception care is a set of interventions that aim to identify and modify
biomedical, behavioral and social risks to a woman’s health or pregnancy outcome through prevention and management
CDC and Select Panel, 2006
Some of these topics are Some of these topics are already covered in my routine already covered in my routine well woman carewell woman care——whatwhat’’s the s the
difference?difference?Comprehensive well woman care is, in fact,
preconception care for women who may become pregnant. Some women may need more than routine well woman care but no
woman needs less.
WHAT IS PRECONCEPTION CARE?
Giving protection
Managing conditions
Avoiding exposures known to be teratogenic
Examining the Examining the Link between Promoting Link between Promoting
WomenWomen’’s Health and s Health and Promoting Preconceptional Promoting Preconceptional
WellnessWellness• Major threats to women’s health are also
major threats to reproductive outcomes.
NUTRITIONAL STATUS: Obesity
Impact of obesity on women’s health:
> Diabetes> Hypertension> Cardiovascular disease> Disabilities
Impact of maternal obesity on reproductive outcomes:
> Glucose intolerance of pregnancy
> Pregnancy induced hypertension
> Thrombophlebitis> Infertility> Neural tube defects> Prematurity
PERIODONTAL DISEASE
Impact of periodontal disease on women’s health:
> Heart disease> Stroke> Serious threat to women
with diabetes, respiratory diseases, osteoporosis
Impact of periodontal disease on reproductive outcomes:
> Evidence accumulating that may be a preventable cause of prematurity
Three Tier Approach to Achieve Higher Levels of Well
Woman/Preconception Wellness
•
General Awareness (Social marketing)
•
Routine Health Promotion (“Every woman, Every time”)
•
Specialty care access
For Every Woman
of Childbearing Potential Every Time
She is Seen
Identify modifiable and nonmodifiable risk factors for poor health and poor pregnancy outcomes
before conceptionProvide timely counseling about risks and strategies
to reduce the potential impact of the risksProvide risk reduction strategies consistent with
best practices.
Summary of CDC/Select PanelSummary of CDC/Select Panel’’s Ten Recommendations s Ten Recommendations to Improve Preconception Health to Improve Preconception Health and Health Careand Health Care
ConsumerIndividual responsibility across the lifespanConsumer awarenessClinicalPreventive visitsInterventions for identified risksInterconception carePrepregnancy checkup
Financing Health insurance coverage for women with low incomesPublic health Programs and StrategiesResearchSurveillance of impactIncrease evidence base